History
- 51 years old man
- Presented with 5 days history of severe left lower limb pain
- Associated with fever, chills, nausea, vomiting, diarrhea and numerous blister lesions over the left lower limb
- Fishing in Lamma Island 3 days before symptom onset
- Good past health
- Not on long term medications
- Drank 2 pints of beer per day, non-smoker
Physical Examination
- Septic and lethargic
- T 40°C
- BP 60/40 mmHg
- PR 120 bpm
- RR 30/min
- SaO2 90% on room air
Investigations
- WCC 33 x 109/L; neutrophil 60%
- Hb 12 g/dL
- Platelet 122 x 109/L
- INR 2
- CK 2350 U/L
- Creatinine 230 umol/L
- ALT 145 U/L AST 465 U/L
Differential Diagnosis
- Gp A streptococcus
- Vibrio vulnificus
- Aeromonas hydrophila
- Clostridium septicum
- Staphylococcus aureus
Diagnosis
- Clinical diagnosis of necrotizing fasciitis
- Blood and tissue culture from debridement: Aeromonas hydrophila
Treatment
- Intravenous 3rd or 4th generation cephalosporins
- Surgical debridement of devitalized tissue as necrotizing fasciitis